High-risk clusters, temporal trends, and demographic determinants of tuberculosis in the Federal District, Brazil,...

Tuberculosis (TB) remains a major public health challenge in Brazil, strongly influenced by social and territorial inequalities. Although the Federal District has a relatively low overall incidence, pronounced internal heterogeneity may conceal localized areas of sustained transmission. This study aimed to analyze temporal trends, spatiotemporal distribution, and demographic and epidemiological determinants of TB incidence in the Federal District, Brazil, from 2010 to 2024. We conducted an ecological study including all newly reported TB cases. Temporal trends were assessed using time-series decomposition and Joinpoint regression. Spatial and space-time clusters were identified using scan statistics, and spatial variation in temporal trends was assessed. A decomposition analysis was conducted to quantify the contributions of population growth, aging, and epidemiological changes in TB incidence. Between 2010 and 2024, 5149 TB cases were reported. The incidence rate increased from 8.5 to 13.1 cases per 100,000 inhabitants, with an initial rise, a prolonged decline until 2022, and a recent resurgence, resulting in an overall increasing trend. Seasonal patterns were stable, with peaks in April and August. Spatial analyses identified persistently high-incidence areas, with a primary space-time cluster in the Administrative Region of Sobradinho during 2012-2018, with a relative risk of 5.39. Localized acceleration of transmission was observed in areas such as Plano Piloto, SIA, and Varjão. Decomposition analysis indicated that changes in TB incidence were driven predominantly by epidemiological factors. In conclusion, TB in the Federal District exhibits dynamic temporal behavior, marked spatial heterogeneity, and concentration of risk in specific territories, largely driven by epidemiological determinants.